scholarly journals Predicting feeding-tube dependence in patients following endotracheal extubation: a two-item swallowing screen

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shu-Fen Siao ◽  
Wen-Hsuan Tseng ◽  
Tyng-Guey Wang ◽  
Yu-Chung Wei ◽  
Tzu-Yu Hsiao ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Feeding Tube ◽  
Oral Feeding ◽  
Invasive Ventilation ◽  
Endoscopic Evaluation ◽  
Icu Patients ◽  
Cough Reflex ◽  
Risk Patients ◽  
To Receive ◽  
Endotracheal Extubation

Abstract Background To meet the surging demands for intubation and invasive ventilation as more COVID-19 patients begin their recovery, clinicians are challenged to find an ultra-brief and minimally invasive screen for postextubation dysphagia predicting feeding-tube dependence persisting for 72 h after extubation. Methods This study examined the predictive validity of a two-item swallowing screen on feeding-tube dependence over 72 h in patients following endotracheal extubation. Intensive-care-unit (ICU) patients (≥ 20 years) successfully extubated after ≥ 48 h endotracheal intubation were screened by trained nurses using the swallowing screen (comprising oral stereognosis and cough-reflex tests) 24 h postextubation. Feeding-tube dependence persisting for 72 h postextubation was abstracted from the medical record by an independent rater. To verify the results and cross-check whether the screen predicted penetration and/or aspiration during fiberoptic endoscopic evaluation of swallowing (FEES), participants agreeing to receive FEES were analyzed within 30 min of screening. Results The results showed that 95/123 participants (77.2%) failed the screen, which predicted ICU patients’ prolonged (> 72 h) feeding-tube dependence, yielding sensitivity of 0.83, specificity of 0.35, and accuracy of 0.68. Failed-screen participants had 2.96-fold higher odds of feeding-tube dependence (95% CI, 1.13–7.76). For the 38 participants receiving FEES, the swallowing screen had 0.89 sensitivity to detect feeding-tube dependence and 0.86 sensitivity to predict penetration/aspiration, although specificity had room for improvement (0.36 and 0.21, respectively). Conclusion This ultra-brief swallowing screen is sufficiently sensitive to identify high-risk patients for feeding-tube dependence persisting over 72 h after extubation. Once identified, a further assessment and care are indicated to ensure the prompt return of patients’ oral feeding. Trial registration NCT03284892, registered on September 15, 2017.

Avaliação das Dietas Enterais mais Utilizadas na Unidade De Terapia Intensiva - AMI

REVISTA FIMCA ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. 32-38
Author(s):  
Bruna de Souza Inês ◽  
Leidiane Rodrigues de Oliveira ◽  
Liliane Rodrigues Leão Leite ◽  
Alcione Altini Paes ◽  
Robson Bandeira da Silva
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nutritional Therapy ◽  
Nutrition Therapy ◽  
Oral Feeding ◽  
Tremendous Importance ◽  
Terapia Intensiva ◽  
Critical Patients ◽  
To Receive ◽  
Porto Velho

Introdução: A terapia nutricional ganhou enorme importância nos últimos 20 anos, tornando-se peça fundamental nos cuidadosdispensados ao paciente crítico. Diante de uma impossibilidade do paciente receber os nutrientes suficientes e necessários para atender às exigências metabólicas por meio de uma alimentação via oral se faz necessário o uso da terapia nutricional enteral, que oferece por via oral a suplementação ou por via sonda as fórmulas enterais. Objetivos: Dessa forma, o objetivo deste trabalho é avaliar as dietas enterais mais utilizadas na Unidade de Terapia intensiva AMI relacionando-as com as patologias e necessidades clínicas dos pacientes. Materiais e Métodos: A pesquisa foi realizada na Unidade de Assistência Medica Intensiva – AMI24H, do hospital e pronto socorro João Paulo II que fica localizada na cidade de Porto Velho – RO durante os trinta e um dias do mês de março/2018. Caracteriza-se por um estudo exploratório, listando as dietas mais utilizadas e relacionando-as com as patologias ou necessidades clínicas dos pacientes. Resultados: As dietas mais utilizadas na unidade foram: Isosource 1.5, Reconvan, Fresubin Original, Nutri Renal, Novasource GC e Fresubin Hepa. As dietas foram relacionadas com os diagnósticos mais prevalentes na unidade apresentando uma adequada relação de acordo com as indicações de uso. Conclusão: Diante do exposto, nesta unidade de terapia intensiva, as dietas utilizadas tem sido bem empregadas quando analisados os diagnóstico mais prevalentes com as dietas existentes, pois dispõem de fórmulas que não só satisfazemas necessidades calóricas, mas tambémfornecemnutrição diferenciada para os pacientes em suas diversas situações clínicas. ABSTRACTIntroduction: Nutrition therapy has gained tremendous importance in the last 20 years, becoming a key element in the care given to critical patients. Faced with an inability of the patient to receive the nutrients sufficient and necessary to meet the metabolicrequirements through oral feeding, it is necessary to use enteral nutritional therapy, which provides orally the supplementation or via the probe enteral formulas. Objectives: The objective of this study is to evaluate the enteral diets most used in the intensive care unit AMI relating to the pathologies and clinical needs of the patients. Materials and Methods: The research was carried out at the Intensive Care Unit - AMI24H of the hospital and emergency room João Paulo II, located in the city of Porto Velho - RO during the thirty-first days of March / 2018. It is characterized by an exploratory study, listing the most used diets and relating them to the pathologies or clinical needs of the patients. Results: The most used diets in the unit were: Isosource 1.5, Reconvan, Original Fresubin, Nutri Renal, Novasource GC and Fresubin Hepa. The diets were related to the most prevalent diagnoses in the unit presenting an adequate relation according to the indications of use. Conclusion: Based on the above, in this intensive care unit, the diets used have been well used when analyzing the most prevalent diagnoses with the existing diets, since they have formulas that not only satisfy the caloric needs, but also provide differentiated nutrition for patients in clinical situations .

scholarly journals Association between the modified Nutrition Risk in Critically Ill (mNUTRIC) score and clinical outcomes in the intensive care unit: a secondary analysis of a large prospective observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Na Wang ◽  
Mei-Ping Wang ◽  
Li Jiang ◽  
Bin Du ◽  
Bo Zhu ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Secondary Analysis ◽  
Nutritional Risk ◽  
Icu Patients ◽  
Nutrition Risk ◽  
Risk Patients ◽  
Youden’S Index

Abstract Background Malnutrition in intensive care unit (ICU) patients is associated with adverse clinical outcomes. The modified nutrition risk in the critically ill score (mNUTRIC) was proposed as an appropriate nutritional assessment tool in critically ill patients, but it has not been fully demonstrated and widely used. Our study was conducted to identify the nutritional risk in ICU patients using the mNUTRIC score and explore the relationship between 28-day mortality and high mNUTRIC scores. Methods This study is a secondary analysis, the data were extracted from The Beijing Acute Kidney Injury Trial (BAKIT). In total, 9049 patients were admitted consecutively, and 3107 patients with complete clinical data were included in this study. We divided the study population into high nutritional risk (mNUTRIC score ≥ 5 points) and low nutritional risk (mNUTRIC score < 5 points) groups. The predictive capacity of the mNUTRIC score was studied by receiver operating characteristic (ROC) curve analysis, appropriate cut-off was identified by highest combined sensitivity and specificity using Youden’s index. The significance level was set at 5%. Results Among the 3107 patients, the 28-day mortality rate was 17.4% (540 patients died). Nearly 28.2% of patients admitted to the ICU were at risk of malnutrition, high nutritional risk patients were older (P < 0.001), with higher illness severity scores than low nutritional risk patients. Multivariate analysis revealed that the mNUTRIC score was an independent risk factor for 28-day mortality and mortality increased with increasing scores (p = 0.000). The calculated area under curve (AUC) for the mNUTRIC score was 0.763 (CI 0.740–0.786). According to Youden’s index, we found a suitable cut-off > 4 for the mNUTRIC score to predict the 28-day mortality. Conclusions Patients admitted to the ICU were at high risk of malnutrition, and a high mNUTRIC score was associated with increased ICU length of stay and higher mortality. More large prospective studies are needed to demonstrate the validity of this score. Trial registration This study was registered at www.chictr.org.cn (registration number Chi CTR-ONC-11001875). Registered on 14 December 2011.

scholarly journals Association between the modified Nutrition Risk in Critically Ill (mNUTRIC) score and clinical outcomes in the intensive care unit: A secondary analysis of a large prospective observational study

2021 ◽  
Author(s):  
Na Wang ◽  
Mei-Ping Wang ◽  
Li Jiang ◽  
Bin Du ◽  
Bo Zhu ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Observational Study ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Prospective Observational Study ◽  
Nutritional Risk ◽  
Icu Patients ◽  
Nutrition Risk ◽  
Risk Patients

Abstract Background: Malnutrition in intensive care unit (ICU) patients is associated with adverse clinical outcomes. The nutrition risk in the critically ill score (NUTRIC) was proposed as an appropriate nutritional assessment tool in critically ill patients. This score uses interleukin-6 (IL-6), a biomarker that is not always available. This prospective observational study was conducted to identify the nutritional risk in ICU patients using the modified NUTRIC (mNUTRIC) score (which does not include IL-6) and to explore the relationship between 28-day mortality and high mNUTRIC scores.Methods: The data were extracted from The Beijing Acute Kidney Injury Trial (BAKIT). This trial was a prospective, observational, multi-centre study conducted in 30 ICUs at 28 tertiary hospitals in Beijing, China, from March 1 to August 31, 2012. In total, 9049 patients were admitted consecutively, and 3107 patients with complete clinical data were included in this study. The predictive capacity of the mNUTRIC score was studied by receiver operating characteristic (ROC) curve analysis. The significance level was set at 5%.Results: Among the 3107 patients, the 28-day mortality rate was 17.4% (540 patients died). High nutritional risk patients were older (P<0.001), with higher illness severity scores than low nutritional risk patients. Multivariate analysis revealed that the mNUTRIC score was an independent risk factor for 28-day mortality and mortality increased with increasing scores (p = 0.000). The calculated area under curve (AUC) for the mNUTRIC score was 0.763 (CI 0.740 - 0.786).Conclusions: Nearly 28.2% of patients admitted to the ICU were at risk of malnutrition, and a high mNUTRIC score was associated with increased ICU length of stay and higher mortality.Trial Registration: This study was registered at www.chictr.org.cn (registration number Chi CTR-ONC-11001875). Registered on 14 December 2011.Key words:The modified nutrition risk in critically ill score, Intensive care unit, Mortality

The Psychosocial Aspects of Feeding in the Neonatal Intensive Care Unit and Beyond

2019 ◽  
Vol 4 (6) ◽  
pp. 1507-1515
Author(s):  
Lauren L. Madhoun ◽  
Robert Dempster
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Hospital Discharge ◽  
Neonatal Intensive Care ◽  
Oral Feeding ◽  
Medical Attention ◽  
Primary Role ◽  
Speech Language Pathologists ◽  
The Family

Purpose Feeding challenges are common for infants in the neonatal intensive care unit (NICU). While sufficient oral feeding is typically a goal during NICU admission, this can be a long and complicated process for both the infant and the family. Many of the stressors related to feeding persist long after hospital discharge, which results in the parents taking the primary role of navigating the infant's course to ensure continued feeding success. This is in addition to dealing with the psychological impact of having a child requiring increased medical attention and the need to continue to fulfill the demands at home. In this clinical focus article, we examine 3 main areas that impact psychosocial stress among parents with infants in the NICU and following discharge: parenting, feeding, and supports. Implications for speech-language pathologists working with these infants and their families are discussed. A case example is also included to describe the treatment course of an infant and her parents in the NICU and after graduation to demonstrate these points further. Conclusion Speech-language pathologists working with infants in the NICU and following hospital discharge must realize the family context and psychosocial considerations that impact feeding progression. Understanding these factors may improve parental engagement to more effectively tailor treatment approaches to meet the needs of the child and family.

scholarly journals Ethnicity and outcomes in patients hospitalised with COVID-19 infection in East London: an observational cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e042140
Author(s):  
Vanessa J Apea ◽  
Yize I Wan ◽  
Rageshri Dhairyawan ◽  
Zudin A Puthucheary ◽  
Rupert M Pearse ◽  
...  
Keyword(s):  
Premature Death ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Organ Support ◽  
Invasive Ventilation ◽  
Black Patients ◽  
Hospitalised Patients ◽  
Observational Cohort ◽  
The Impact ◽  
To Receive

ObjectiveTo describe outcomes within different ethnic groups of a cohort of hospitalised patients with confirmed COVID-19 infection. To quantify and describe the impact of a number of prognostic factors, including frailty and inflammatory markers.SettingFive acute National Health Service Hospitals in east London.DesignProspectively defined observational study using registry data.Participants1737 patients aged 16 years or over admitted to hospital with confirmed COVID-19 infection between 1 January and 13 May 2020.Main outcome measuresThe primary outcome was 30-day mortality from time of first hospital admission with COVID-19 diagnosis during or prior to admission. Secondary outcomes were 90-day mortality, intensive care unit (ICU) admission, ICU and hospital length of stay and type and duration of organ support. Multivariable survival analyses were adjusted for potential confounders.Results1737 were included in our analysis of whom 511 had died by day 30 (29%). 538 (31%) were from Asian, 340 (20%) black and 707 (40%) white backgrounds. Compared with white patients, those from minority ethnic backgrounds were younger, with differing comorbidity profiles and less frailty. Asian and black patients were more likely to be admitted to ICU and to receive invasive ventilation (OR 1.54, (95% CI 1.06 to 2.23); p=0.023 and OR 1.80 (95% CI 1.20 to 2.71); p=0.005, respectively). After adjustment for age and sex, patients from Asian (HR 1.49 (95% CI 1.19 to 1.86); p<0.001) and black (HR 1.30 (95% CI 1.02 to 1.65); p=0.036) backgrounds were more likely to die. These findings persisted across a range of risk factor-adjusted analyses accounting for major comorbidities, obesity, smoking, frailty and ABO blood group.ConclusionsPatients from Asian and black backgrounds had higher mortality from COVID-19 infection despite controlling for all previously identified confounders and frailty. Higher rates of invasive ventilation indicate greater acute disease severity. Our analyses suggest that patients of Asian and black backgrounds suffered disproportionate rates of premature death from COVID-19.

scholarly journals Lung ultrasound predicts clinical course but not outcome in COVID-19 ICU patients: a retrospective single-center analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stephanie-Susanne Stecher ◽  
Sofia Anton ◽  
Alessia Fraccaroli ◽  
Jeremias Götschke ◽  
Hans Joachim Stemmler ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Lung Ultrasound ◽  
Clinical Course ◽  
Point Of Care ◽  
Clinical Deterioration ◽  
Normal Lung ◽  
Icu Patients ◽  
Standardized Protocol ◽  
Ultrasound Score

Abstract Background Point-of-care lung ultrasound (LU) is an established tool in the first assessment of patients with coronavirus disease (COVID-19). Purpose of this study was to evaluate the value of lung ultrasound in COVID-19 intensive care unit (ICU) patients in predicting clinical course and outcome. Methods We analyzed lung ultrasound score (LUS) of all COVID-19 patients admitted from March 2020 to December 2020 to the Internal Intensive Care Unit, Ludwig-Maximilians-University (LMU) of Munich. LU was performed according to a standardized protocol at ICU admission and in case of clinical deterioration with the need for intubation. A normal lung scores 0 points, the worst LUS has 24 points. Patients were stratified in a low (0–12 points) and a high (13–24 points) lung ultrasound score group. Results The study included 42 patients, 69% of them male. The most common comorbidities were hypertension (81%) and obesity (57%). The values of pH (7.42 ± 0.09 vs 7.35 ± 0.1; p = 0.047) and paO2 (107 [80–130] vs 80 [66–93] mmHg; p = 0.034) were significantly reduced in patients of the high LUS group. Furthermore, the duration of ventilation (12.5 [8.3–25] vs 36.5 [9.8–70] days; p = 0.029) was significantly prolonged in this group. Patchy subpleural thickening (n = 38; 90.5%) and subpleural consolidations (n = 23; 54.8%) were present in most patients. Pleural effusion was rare (n = 4; 9.5%). The median total LUS was 11.9 ± 3.9 points. In case of clinical deterioration with the need for intubation, LUS worsened significantly compared to baseline LU. Twelve patients died during the ICU stay (29%). There was no difference in survival in both LUS groups (75% vs 66.7%, p = 0.559). Conclusions LU can be a useful monitoring tool to predict clinical course but not outcome of COVID-19 ICU patients and can early recognize possible deteriorations.

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